Class of 2017 Abstract / Objectives: To assess the change in efficiency and accuracy of the medication reconciliation process at the Pima County Adult Detention Center (PCADC) after implementation of a Health Information Exchange (HIE) and also to identify the percentage of patients whose medication data is available in the HIE Methods: This program evaluation was a retrospective comparison of the traditional self-reported method of medication reconciliation to the HIE method. It compared the number and types of medication discovered for each patient using the traditional medication reconciliation collection data (the self-reported method) and the new database query method (HIE method) Results: 200 samples were randomly selected (100 random detainees and 100 with known medical record in the HIE database) to participate in the study. A total of 150 patients (61%) were retrieved from the HIE database, of which 100 were from the control group and 50 from the random group. The total numbers of medications that these 150 patients contributed was 284. Mean completeness of self-reported medications was 54% while HIE yielded an average of 99% (χ2; p<0.0001). 9 patients (4%) had both self-reported medications and medications within the HIE database in which 17 medications (62%) compared to the self-reporting method with 14 medications (52%) sharing the same name. There were no medication dose matches between self-reported medications and HIE queried medications. Conclusions: The addition of an HIE database to the existing self-reporting process of collecting a detainee’s medication reconciliation provides a more comprehensive and accurate medical record

Class of 2014 Abstract / Specific Aims: Assess the change in efficiency and accuracy of healthcare in provider access to HIE for medication profiles at the PCADC. Methods: Adults detainees admitted from October 22, 2012 to July 31, 2013 were enrolled in this study. A completed Intake Medical Screening form with self-reported/correction facility staff verified medication list will (the old method) be compared to the medication list obtained by querying the medication HIE (the new method). Descriptive statistics will describe the patients. Statistical significance will be calculated using the McNemar chi-square test for comparing the proportions of omissions (medications and strengths) on the 765PI to the HIE with an a priori alpha of 0.05. Main Results: In progress. Conclusion: HIE has the potential to be a valuable tool for healthcare providers operating at an adult detention facility.

Class of 2016 Abstract and Report / Objectives: To evaluate the successes and failures of the recent implementation of the Arizona Health-e Connection (AzHeC) health information exchange (HIE) at the Pima County Adult Detention Center (PCADC); to identify a generalized infrastructure and draft recommendations for implementing HIE at other correctional facilities. Methods: Participants pertinent to the implementation by current staff at the PCADC were identified through snowball sampling. Interviews were conducted in-person or by telephone using a semi-structured interview guide. Demographics regarding roles and responsibilities during implementation were collected during each interview. Participants were asked for input regarding key aspects and lessons learned from the implementation. Interviews were audio-recorded, transcribed verbatim, and then analyzed with Atlas.ti software for common themes. Results: A total of 12 individuals were interviewed, providing a comprehensive set of perspectives. Six common themes were identified: impact of being a novel implementer; challenges surrounding implementation; problems during implementation; what was done well; benefits of the system; and communication during implementation. Potential barriers that were successfully anticipated were establishing the value of the HIE through pilot studies to obtain early stakeholder buy-in, and addressing legal/privacy issues for the at-risk population in the corrections system. Problems that arose during implementation often involved information technology issues. Conclusions: Despite challenges faced throughout the HIE implementation, improvements in patient care, workflow, and time-savings made a tremendous impact for those involved. The lessons learned and advice given by the participants of this study can provide guidance for other correctional health systems wishing to implement a HIE at their facility.

abstract: Blockchain technology enables a distributed and decentralized environment without any central authority. Healthcare is one industry in which blockchain is expected to have significant impacts. In recent years, the Healthcare Information Exchange(HIE) has been shown to benefit the healthcare industry remarkably. It has been shown that blockchain could help to improve multiple aspects of the HIE system. When Blockchain technology meets HIE, there are only a few proposed systems and they all suffer from the following two problems. First, the existing systems are not patient-centric in terms of data governance. Patients do not own their data and have no direct control over it. Second, there is no defined protocol among different systems on how to share sensitive data. To address the issues mentioned above, this paper proposes MedFabric4Me, a blockchain-based platform for HIE. MedFabric4Me is a patient-centric system where patients own their healthcare data and share on a need-to-know basis. First, analyzed the requirements for a patient-centric system which ensures tamper-proof sharing of data among participants. Based on the analysis, a Merkle root based mechanism is created to ensure that data has not tampered. Second, a distributed Proxy re-encryption system is used for secure encryption of data during storage and sharing of records. Third, combining off-chain storage and on-chain access management for both authenticability and privacy. MedFabric4Me is a two-pronged solution platform, composed of on-chain and off-chain components. The on-chain solution is implemented on the secure network of Hyperledger Fabric(HLF) while the off-chain solution uses Interplanetary File System(IPFS) to store data securely. Ethereum based Nucypher, a proxy re-encryption network provides cryptographic access controls to actors for encrypted data sharing. To demonstrate the practicality and scalability, a prototype solution of MedFabric4Me is implemented and evaluated the performance measure of the system against an already implemented HIE. Results show that decentralization technology like blockchain could help to mitigate some issues that HIE faces today, like transparency for patients, slow emergency response, and better access control. Finally, this research concluded with the benefits and shortcomings of MedFabric4Me with some directions and work that could benefit MedFabric4Me in terms of operation and performance. / Dissertation/Thesis / Masters Thesis Computer Engineering 2020

Indiana University-Purdue University Indianapolis (IUPUI) / Physicians receive multiple CCDs for a single patient encompassing various encounters and medical history recorded in different information systems. It is cumbersome for providers to explore different pages of CCDs to find specific data which can be duplicated or even conflicted. This study describes the steps towards a system that integrates multiple CCDs into one consolidated document for viewing or processing patient-level data. Also, the impact of the system on healthcare providers’ perceived workload is evaluated. A modular system is developed to consolidate and de-duplicate CDA-based documents. The system is engineered to be scalable, extensible and open source. The system’s performance and output has evaluated first based on synthesized data and later based on real-world CCDs obtained from INPC database. The accuracy of the consolidation system along with the gaps in identification of the duplications were assessed. Finally, the impact of the system on healthcare providers’ workload is evaluated using NASA TLX tool. All of the synthesized CCDs were successfully consolidated, and no data were lost. The de-duplication accuracy was 100% based on synthesized data and the processing time for each document was 1.12 seconds. For real-world CCDs, our system de-duplicated 99.1% of the problems, 87.0% of allergies, and 91.7% of medications. Although the accuracy of the system is still very promising, however, there is a minor inaccuracy. Due to system improvements, the processing time for each document is reduced to average 0.38 seconds for each CCD. The result of NASA TLX evaluation shows that the system significantly decreases healthcare providers’ perceived workload. Also, it is observed that information reconciliation reduces the medical errors. The time for review of medical documents review time is significantly reduced after CCD consolidation. Given increasing adoption and use of Health Information Exchange (HIE) to share data and information across the care continuum, duplication of information is inevitable. A novel system designed to support automated consolidation and de-duplication of information across clinical documents as they are exchanged shows promise. Future work is needed to expand the capabilities of the system and further test it using heterogeneous vocabularies across multiple HIE scenarios.

The growth of e-health system has influenced the way health organizations conducttheir business. Communication between these systems is one of the most significantfactors since a more efficient communication system can improve an organizationperformance. Nowadays the health organizations make a lot of investments to deploya suitable information and communication technology to meet their goals.This study investigates the health information exchange within different healthinformation systems. We first carried out a theoretical study to find out the relevantconcepts by reviewing the related literature and analyzing them. As a result of ourtheoretical study we investigate and redesign the basic model of the “Super Clinic” asa new model for health information exchange system. Then we conducted anempirical study to validate the result from the theoretical study which helped us tonarrow down our research area. We revised our proposed theoretical model by thelesson learnt from our empirical study results. Three interviews were conducted withexperts and the outcomes were analyzed using comparative analysis. These interviewsallowed us to outline the most important factors of successful health informationexchange systems (i.e. “Super Clinic”).They also helped us to design a central hub (i.e. “health Hub”) for communicationand information exchange between different information systems. This revised modelof Super Clinic (with the central hub) could be going under more investigation infuture works. / Program: Masterutbildning i Informatik

In a context where technology is increasingly being incorporated into health care practice, many U.S. health care providers and organizations are finding it challenging to connect disparate electronic documentation systems to retrieve patient information when coordinating care across providers and heath care entities. Local and regional health information exchange (HIE) systems were created to facilitate collecting information into one integrated patient record to address information transfer between heath care providers. Yet, adoption and use of HIEs have been low. The purpose of this study was to review the predictive factors accounting for physicians' use of a HIE in the U.S. state of Hawaii. Key factors from the technology acceptance model were evaluated to determine the behavioral intention resulting in actual use of the Hawaii health information exchange (HHIE). Physician characteristics (medical specialty, age, and gender) and location characteristics were also assessed. The total population of the study contained 1034 Hawaii physicians who have signed up to use the HHIE. Linear and logistic regression models were structured to evaluate the predictive nature of (a) use to determine if a physician has ever logged into the HIE and (b) usage to evaluate the extent to which a physician is logging into the HIE. Findings from the study reveal a predictive relationship between the characteristic of medical specialty and HHIE use when comparing primary care and emergency department physicians to physician specialists. Using study results, health care leaders can improve physician outreach and review barriers when using the HIE systems to coordinate care. Policy implications include the possible formulation of future requirements surrounding HIE physician participation.